What is an appropriate initial treatment for superior vena cava syndrome presenting with neurologic deficit?

• A. Aspirin
• B. Oxygen therapy
• C. Intravenous dexamethasone
• D. Surgical stenting

Answer: (C)

The key idea is that neurologic deficits in superior vena cava syndrome come from cerebral edema due to venous congestion. The fastest way to relieve that edema and reduce intracranial pressure is to use a potent anti-inflammatory that decreases capillary permeability and surrounding tissue swelling. Intravenous dexamethasone does exactly that, often producing rapid improvement in neurologic symptoms and buying time for definitive therapy (such as radiation, chemotherapy, or vascular intervention) depending on the underlying cause. Oxygen helps with hypoxemia but doesn’t address the underlying edema or venous obstruction, aspirin has no role in reducing the edema or obstruction, and surgical stenting, while helpful for definitive relief, isn’t the immediate first step when neurologic signs are present.